A single tensor fasciae latae musculocutaneous and fascia flap for composite reconstruction of urogenital and groin defect.

The tensor fasciae latae flap is a well known musculocutaneous flap used for many indications in the field of plastic surgery. The flap has some modifications to fit different reconstructive requirements of the defects. Osseous-muscle flap, osseous musculocutaneous flap, muscle flap, muscle-fascial flap and musculocutaneous-fasciocutaneous flap are some known alternatives. We used a modification of this well-known flap as musculocutaneous and fascia flap for a composite reconstruction of groin and urogenital defect. We reconstructed the groin defect with musculocutaneous part of the flap, and the defect over neourethra with the fascial extension and grafting. The aim of this modification was to reconstruct a genital defect with a thin and more pliable tissue to overcome the problem of distortion, kinking and thickness of the flap.     

Reconstruction of sternal defects with pectoralis major muscle flap

The earliest treatment of the median sternotomy defects was serial debridements and secondary healing. The muscle flaps that can be used in reconstruction of the presternal defects are pectoralis major muscle flap, rectus abdominis muscle flap, vertical rectus abdominis muscle flap, latissimus dorsi muscle flap with or without skin island, bipedicled pectoralis-rectus muscle flap, and external oblique muscle flap. Pectoralis major muscle flap can be used either as bilateral or unilateral rotation advancement flap, island flap, turnover flap, split turnover flap, and segmental muscle flap. Forty-eight patients with median sternotomy defects, who were treated with pectoralis major muscle flap, were included in this study. The complications were mortality, flap loss, flap dehiscence, persistent infection, and hematoma. The patients were evaluated in terms of functional loss after the operation by shoulder movement measurements. Various techniques of flap transfer can be used for the closure of a presternal defect; almost all presternal defects can be covered with the pectoralis major muscle in a single stage operation. In our opinion, the pectoralis major muscle flap should be the first choice of treatment for sternal defects.     

随意型皮瓣蒂宽瓣宽比例与皮瓣成活长度关系的实验研究

目的揭示随意型皮瓣蒂宽瓣宽比例与皮瓣成活长度的关系。方法在6只小猪背躯干部制作7组瓣同蒂不同、蒂同瓣不同的42块窄蒂随意型皮瓣,对其进行荧光素钠染色、ECT 静态和动态血流测定、成活面积微机分析等观察。结果①在机体一定部位窄蒂随意型皮瓣蒂宽的变化不影响瓣的成活长度,因此宽蒂设计并不具明显临床意义且不便于旋转。②在相同长度下皮瓣的宽度超过蒂宽的3或4倍不影响皮瓣的成活,但成活面积却因瓣宽变化而显著增加。③随意型皮瓣一定宽度的蒂部所带动的皮瓣成活面积接近以成活长度为半径的半圆形范围。结论机体一定部位随意型皮瓣的成活长度有其固有值,且蒂、瓣宽比例在1:3～1:4范围内变化不影响皮瓣成活。     

Role of the anterolateral thigh flap in head and neck reconstruction: advantages of moderate skin and subcutaneous thickness

Skin-flap thickness is an important consideration when choosing a free flap for head and neck reconstruction. The anterolateral thigh flap, the rectus abdominis flap, and the radial forearm flap, which included the epidermis, the dermal, and the subcutaneous layers, were measured using ultrasonography in 31 patients. The mean skin and subcutaneous thickness of the anterolateral thigh flap was 7.1 mm; the rectus abdominis flap was 13.7 mm; and the radial forearm flap was 2.1 mm. Further analysis revealed a statistically significant difference among the skin and subcutaneous thickness of the three flap groups. Of the 44 anterolateral thigh flap transfers done for head and neck reconstruction after cancer ablative surgery, 41 (93.2 percent) were transferred successfully. The anterolateral thigh flap creates a moderately thick skin flap, and is less variable in thickness across its area than is the rectus abdominis flap. The flap is adaptable for reconstruction of head and neck soft-tissue defects.     

Advancement Flaps: A Basic Theme with Many Variations

Background. The advancement flap involves the linear advancement of tissue in one direction. Despite its straightforwardness and simple concept, it can be used to close a variety of defects, ranging from small defects on the scalp or extremities to large, complicated defects involving cosmetic units on the face.
Objectives. To provide a basic and useful review for the indications, advantages, disadvantages, and techniques for the use of advancement flaps in the reconstruction of defects in dermatologic surgery.
Materials and Methods. We performed a literature search for articles discussing advancement flaps and compiled a brief review of our findings.
Results. The movement of the advancement flap must be balanced by the blood supply of the flap. The excision of Burow's triangles along various aspects of the advancement flap can increase movement and improve cosmesis of the flap. The types of advancement flaps discussed include the single advancement flap, double advancement flap, A-T flap (O-T flap), Burow's triangle flap (Burow's wedge flap), crescenteric advancement flap, island pedicle flap (V-Y flap), helical rim advancement flap, and facelift flap.
Conclusion. Advancement flaps are versatile and useful basic flaps for repairing defects.     

随意型皮瓣蒂宽瓣宽比例与皮瓣成活长度关系的实验研究

目的 提示随意型皮瓣蒂宽瓣比例与皮瓣成活长度的关系。方法 在６只小猪背躯干部制作７组瓣同蒂不同、蒂同瓣不同的４２块随意型皮瓣,对其进行荧光素钠染色、ＥＣＴ静态和动态血流测定、成活面积微机分析等观察。结果 ①在机体一定蒂随意型皮瓣蒂宽的变化不影响瓣的成活长度,因此宽蒂设计并不具明显临床意义且不便于旋转。②在相同长度下皮瓣的宽度超过蒂宽的３或５倍不影响皮瓣的成活,但成活面积却因瓣宽变化面显著增加。③随     

Anterolateral thigh flap technique in hand and upper extremity reconstruction

The anterolateral thigh flap is an extremely versatile flap first described in 1984. The flap is based on either a septocutaneous or musculocutaneous perforator of the descending branch of the lateral circumflex femoral system. It can be designed as a skin and subcutaneous flap, fasciocutaneous, or musculocutaneous flap. Furthermore, it can be harvested as a sensate flap by taking the lateral cutaneous nerve of the thigh. Technique for harvesting the flap is described in detail. Complications include flap failure and donor site morbidity. Due to its versatility, the anterolateral thigh flap is particularly useful for upper extremity reconstruction.     

The saphenous flap called the Acland's flap. Report of 2 cases]

The authors present two cases of Acland's flap. This flap described and published in 1981, is a very good flap, but the myocutaneous flaps have limited its use. However, the authors believe that there are indications for this saphenous flap. The vascular supply for this flap is a saphenous artery, the last branch of the femoral artery, before it becomes the popliteal artery. The authors report two cases: one neurovascular island flap for the posterior side of the knee, and the other case is a free flap for forearm. This flap is part of a particularly rich arterial network on the medial side of the thigh and of the knee. Masquelet, in 1986, showed that it is possible to raise a periosteal flap or a vascularized tendon flap.     

Resurfacing difficult wounds: selective use of the posterior tibial flap

The posterior tibial flap is a type C fasciocutaneous flap from the medial calf with the posterior tibial vascular bundle as its pedicle. Most of the skin perforators, 1 to 3 in number, can be found in the middle third of the leg, with an average diameter of 0.8 mm and an average length of 22 mm. The posterior tibial artery ranges between 1.5 and 2.0 mm in diameter, although it is absent in 8 percent of limbs. Since the saphenous nerve is taken with the flap, this is an innervated flap. The flap can be transferred as a free flap or a pedicled flap. The reversed-flow pedicled flap has an average pedicle length of 8 cm. The posterior tibial flap is a reliable, large, thin, innervated flap and can be raised with the patient supine. Case reports are presented of six patients who received a free flap transfer and of one patient who received a reversed-flow pedicled flap. There were two cases of heel ulcerations, two crushed hands, one chronic ulceration and osteomyelitis of the tibia, one burn contracture of the neck, and one salvage flap for diabetic gangrene of the hand.     

Clinical application of a paraumbilical axial flap--report of 16 cases

The paraumbilical skin flap is based on the deep inferior epigastric artery and its paraumbilical perofrators. It can be transferred not only as a free flap but also as a pedicle flap or island flap. Since December 1987, we have successfully used the flap to repair the wounds and to reconstruct penis in 16 cases. The merits of the flap are as follows: The position of deep inferior epigastric artery is constant. The blood supply to the flap is good. The flap has a long vascular pedicle and the donor site is concealed.     

Lateral thigh free flap with flow-through vascular pedicle

The lateral thigh flap based on the second and third perforator of profunda femoris vessel has not become very popular. We describe a technique of flow-through pedicle for this flap. The flow-through technique makes this flap very simple to transfer. The flap was used successfully in 6 cases for reconstruction for defects in the leg and forearm. The flow-through pedicle is ideal for lower limb reconstruction. The anastomosis becomes very easy and safe, even if the recipient vessels are deep in the intermuscular septum. We had no flap failures. The flap has a very predictable anatomy. Large flaps from anteriolateral and posterior part of midthigh can be safely elevated. The flap can meet a variety of requirements as it can be thin skin-alone flap, a fasciocutaneous flap, or even a musculocutaneous flap. A simple pinch test gives a fair idea of expected flap thickness. The dissection requires strong retraction of the anterior thigh muscles, but the dissection is safe and simple. The donor-site morbidity is very minimal.     

Anterolateral thigh flap

The anterolateral thigh (ALT) flap is a versatile soft tissue flap. It can be harvested as a fasciocutaneous or myocutaneous flap. Vascularized fascia can be included or the pedicle may be harvested as a flow‐through flap. The flap can also be harvested incorporating multiple skin islands or as a chimeric flap incorporating separate skin and muscle components. When a large flap is needed, the entire lateral thigh can be harvested by combining the ALT with either the tensor fascia lata or the anteromedial thigh flap as a conjoined flap. Morbidity is remarkably minimal despite the availability of such generous amounts of tissue. The purported difficulty with the use of this flap is because of the anatomical variations that may render this flap unreliable. This paper clarifies the vascular anatomy of the flap and elaborates an approach to flap harvest that can be used to reliably harvest the flap in spite of the anomalies that may be encountered. © 2009 Wiley Periodicals, Inc. Head Neck, 2010     

To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects.

The anterolateral thigh (ALT) flap has achieved popularity recently for free-flap reconstruction of intraoral defects following excision of squamous cell carcinoma. We have assessed the feasibility of the ALT flap as a free flap for oral lining and the potential use of the thinned ALT flap in a one-stage reconstruction. We used the ALT flap to reconstruct the oral cavity in 18 consecutive patients between December 2000 and December 2001 following intraoral resection of squamous cell carcinoma. Twelve patients underwent reconstruction using a standard ALT flap, four patients received a thinned ALT flap in a one-stage procedure, one patient received a standard ALT flap in combination with a fibula flap and one patient received a combination of a standard ALT flap and vascularised iliac bone. There were no complications in any of the 14 cases in which a standard ALT flap was used. Two of these flaps were thinned subsequently as secondary procedures. Of the four thinned ALT flaps, one flap failed completely and two flaps experienced partial necrosis. In all but one case the donor site was closed directly with minimal donor-site morbidity. The ALT flap is a versatile flap that can be used in combination with other flaps for more complex defects with minimal donor-site morbidity and is a useful alternative in the armamentarium of the head and neck surgeon. Thinning of the flap is best performed as a secondary procedure, should it be required.     

Successful retrograde arterial inflow through a muscular branch in a free anterolateral thigh chimeric flap transfer

In this report, we present a case in which a free anterolateral thigh (ALT) flap was transferred for head and neck reconstruction after oropharyngeal cancer ablation, and a retrograde arterial inflow was used to salvage the flap when the main arterial pedicle showed usual repeated spasms. The flap was raised as a chimera flap comprising a fasciocutaneous flap and a vastus lateralis muscle flap. After reperfusion, the pedicle artery exhibited spasms repeatedly and vascular flow was unstable. Therefore, we performed arterial supercharge. In the distal portion of the muscle flap, a small arterial branch was dissected as a reverse-flow arterial pedicle. The recipient artery was also a retrograde limb of the superior thyroid artery. The flap survived; however, postoperative ultrasonographic echo evaluation revealed that the spastic descending branch of the lateral circumflex femoral artery was obstructed and that the reverse-flow muscular perforator alone nourished the whole flap. In free ALT flap transfer, a small perforator level artery was able to nourish a flap, even in a retrograde manner. Moreover, when the vasculature of the free flap is unstable, retrograde arterial supply to a small perforator can be an option to save the flap transfer.     

皮瓣移植在我国烧伤外科中的应用

The history and application of surgical flap transplantation in burn wound were briefly reviewed. We outlined skin flap, muscuiocutaneous flap, fascia flap and neurocutaneous vascular flap in this paper and recommended repair deep wounds with flap. All in all, in this review, we hope to provide a meaningful option for clinical application of surgical flap in the future.     

Recycled free septocutaneous perforator flap

In planning the sequential transfer of free flaps with an adequate time interval, the transferred prior flap can be considered a potential donor site when it becomes partially dispensable as a result of redundancy. Increased control of the range of flap thickness is one of the advantages of a perforator flap. Therefore, a transferred perforator flap with a redundancy in thickness could be reelevated later as a thin perforator flap that leaves significant subcutaneous tissue intact. We present an unusual case in which a prior free perforator flap was reelevated as a thin flap and transferred as a free flap to another location. Two years after the first transfer, the medial thigh septocutaneous perforator-based flap in the calf region was elevated again, with only the inclusion of a thin subcutaneous layer based on the same perforator pedicle, and was moved as a free flap to the anterior tibial region. The use of a prior perforator flap as a donor site for a later flap can avoid the additional sacrifice of a new donor site. The recycling of redundant perforator flaps to yield another flap through tangential splitting is another advantage of perforator flaps.     

Evaluation of total vs. regional blood perfusion with a laser Doppler imaging system in the rat epigastric flap

Monitoring systems to measure flap survival are either invasive, touch the surface of the tissue, or have problems in reproducibility. The authors sought to determine the efficacy of a laser Doppler imaging (LDI) system to measure perfusion in a myocutaneous flap, by producing a two-dimensional picture of the flap without touching the surface. They compared total flap perfusion with perfusion in selected areas of interest after flap surgery. The perfusion in the left groin of Sprague-Dawley rats was measured before and after surface rubbing, skin injury, and during different lighting conditions. The perfusion of the epigastric flap before and over a period of 60 min after elevation was measured, and values were compared to pre-surgical values and to sham-operated animals. They determined the differences between single and running-suture techniques after flap surgery, as well as between venous and/or arterial occlusion. Surface rubbing, skin injury, and light influenced the LDI image. After flap elevation, total flap perfusion remained stable, while the distal area (area 8, n = 7) of the flap showed a statistically significant decrease in perfusion (71 +/- 5.9 vs. 92 +/- 9.5 percent perfusion units--PU; p < .05). The proximal areas (1 to 3, n = 7) of the flap had a higher perfusion at 60 min after flap surgery, compared with sham-operated (n = 8) animals (118 +/- 12.5 vs. 97 +/- 10.4 percent PU; p < .05). The running-suture technique was followed by decreased perfusion on the peripheral side of the flap, compared with the single-suture technique (73.7 +/- 9.2 vs. 99.2 +/- 4.9 percent PU; n = 2). The LDI was able to visualize venous and/or arterial occlusion after flap surgery. Under standardized circumstances (light, temperature), the LDI was efficient in measuring regional flap circulation experimentally. While total flap perfusion after flap surgery remained stable, perfusion in the distal flap decreased significantly.     

猪背部乒乓球拍样任意型皮瓣成活的动物实验研究

目的 探讨乒乓球拍样任意型皮瓣成活面积与窄蒂长宽比例关系.方法 25只猪随机分成5组,在5组猪的背部分别形成不同长宽比例的狭长窄蒂和5个不同面积的任意型皮瓣.对每组皮瓣进行大体观察、荧光色素钠染色、单光子发射计算机断层仪（ECT）血流量测定、成活面积分析等.结果 当狭长窄蒂的长宽比例不变时,随着皮瓣面积的增加,皮瓣成活面积也随之增大,但达一定限度时皮瓣远端即发生坏死,而成活面积并未缩小;当皮瓣面积不变,随着狭长窄蒂的长宽比例增加,皮瓣成活面积不受影响,但达一定限度时皮瓣远端即发生坏死,皮瓣成活面积缩小.结论 狭长窄蒂任意型皮瓣是一种简便实用的任意型皮瓣,蒂部可以设计成狭长状,蒂瓣的长宽比远小于传统的比例,在一定范围内增大皮瓣面积或蒂部的长宽比例不会导致皮瓣坏死.     

Free flap reconstruction in massive upper extremity burns

In massive burns, early excision and a free flap reconstruction is, in some cases, limb saving. From October 1979 to August 1993, eleven patients with massive burn injury in the upper extremity were treated using a free flap reconstruction. Eight cases were acute or subacute and three were late reconstructions. The following free flaps were used: rectus femoris microneurovascular musculocutaneous flap (2), latissimus dorsi flap (4), rectus abdominis flap (3), gluteal thigh flap (1), lateral arm flap (1), and serratus flap (1). The gluteal thigh flap was lost and it was later replaced by a rectus abdominis flap. In three cases successful reanastomosis was performed. Functional late reconstructions were performed in nine patients. In all eleven patients the limb was saved and functional recovery was satisfactory. We recommend that a free musculocutaneous or muscle flap is used, proximal to the wrist, if after careful excision of nonviable tissue, tendons, bone joint or major vessels are exposed. The rectus femoris musculocutaneous flap is a useful solution to restore extensor musculature of the forearm after extensive injury.